Strengthening and Integrating Palliative Care in Four African Countries

Image

In April 2012, the UK Department for International Development approved a three-year project through the Tropical Health Education Trust's (THET) Health Partnerships Multi-country Partnership Scheme to support the programme for strengthening palliative care integration into national health systems in four African countries (Kenya, Rwanda, Uganda and Zambia).

The grant was awarded to the Global Health Academy at the University of Edinburgh (UoE), who work in conjunction with the African Palliative Care Association (APCA), and Makerere University Palliative Care Unit (MPCU).

Project Description

The project goal is to support the development of a comprehensive public health primary care approach to palliative care which includes service provision, support systems and supply chain mechanisms that are firmly integrated into each countries’ health system.

Image

The project aims to do this through a modelling approach. The Ministry of Health in each country has identified 3 representative hospitals and within these hospitals the programme is working with management, senior staff, all practitioners across different specialities and the palliative care team to develop the comprehensive service. Emerging from the programme will be a series of exemplars of these 12 hospital based palliative care providing models of best practice in large teaching hospitals, in hospitals serving rural catchment areas and in District hospitals providing pathways of care between primary and tertiary services.

The programme builds on the different stages of palliative care development of each country. The multi-layered approach with the hospitals and their associated health centres is working in the following way:

• Strengthening the knowledge, skills and acceptability of palliative care among 480 health workers (from senior policy and management to community practitioner) to deliver integrated holistic care through a range of on-site (hospital/health centre) multi-disciplinary, multi-cadre trainings, and the development and implementation of contextualised patient and provider resources.
• UK mentors (generated through Edinburgh’s extensive palliative care mentoring UK network) are being levered to facilitate and grow the African Palliative Care Association’s (APCA) Mentorship Programme with each hospital matched to a lead UK mentor and a small mentorship support network
• Establishing and integrating pathways (including through m-health) for diagnosis, treatment and care through a multi-level health care team alongside development of protocols, planning templates for health service management to, record keeping and patient documentation to draw together all palliative care work
• Brokering linkages across budgetary, national policy and regulatory frameworks to on-the-ground practice in order to establish a whole system approach to palliation by working with senior management and palliative care partners and strengthening advocacy
• Strengthening and uniting the current multiple community responses to palliative care, and building on community capital through a public engagement approach with local champions and opinion makers

 

Outcomes

Image

• Strengthened local and international partnerships to enhance project coordination, ownership, value for money and sustainability through the development of MOUs and TORs for the project partners
• An established north-south, and south-south twinned mentorship programme for ongoing support supervision for trained health professionals, and health managers
• A workforce adept in the understanding and the practice of palliative care in the targeted hospitals with the intent of snowballing this to other health facilities
• Appropriate training materials that will support capacity development for health professionals in each country
• A viable and integrated system of palliative care services (including patient records) for PLWHA (adults and children) accessing care in the targeted hospitals and downstream health centres, dispensaries, and home based care programmes supported by seamless linkages, and an effective referral systems between the hospital/ health facilities and communities
• A culture of palliative care with acceptance of its value at all levels from senior hospital management through all cadres of health workers

Image

Outputs

480 health professionals selected from three main hospitals in four partner countries working with enhanced skills, confidence and knowledge in regard to all patients requiring a palliative care approach. The professionals have identified the following criteria for success.

• A strong understanding of the dimensions of palliative care including early decision making and planning, palliative treatment options and home care needs
• Skills to deliver supportive and palliative care
• Confidence to be fully empathetic to palliative care needs and confident to speak about palliative care issues, and death and dying, breaking bad news
• Ability to run community and health facility sessions on the holistic nature of palliative care
• Ability to facilitate a cyclical care regime recognising some patients on ART can be drawn back from palliative care to rehabilitative care

• Twelve sets of clinical guidelines, Pathway plans for referral and follow-up, protocols and mentorship frameworks developed to support ongoing learning for each target hospital beyond the project duration.
• Improved understanding, skills and knowledge of all cadres of all health workers in regard to patients with all life limiting illnesses.

• Palliative care services and pathways integrated as part of comprehensive treatment, care and support for all people requiring end of life care in each of the 12 public referral hospitals
• Increase in the number of people* requiring end of life care able to access comprehensive palliative care from their preferred place of care in community.
• Increase in the number of patients* who have had a palliative care assessment carried out while on wards and increased number of patients discharge summaries from hospital with a palliative care discharge summary (Increase of 25% from baseline at beginning of project)

Image

Resources

Project Evaluation

Integrate PC Toolkit 

Developed by members of the Integrate Project 

Makerere Palliative Care Unit (MPCU) 

Primary Palliative Care Research Group, University of Edinburgh 

These toolkits and  information remain the property of The University of Edinburgh, Global Health Academy, if you would like to use  any of this information please contact globalhealth@ed.ac.uk